Admission Troponin I and Post Thrombolytic ST-Segment Resolution in Prediction of Early Risk Stratification in ST-...

The prognostic value of admission troponin I (tnI) levels and the resolution of the ST-segment elevation in ST-elevation myocardial infarction (STEMI) is well established. However, the combination of these two early available markers for predicting the risk of early mortality has not been evaluated yet. This prospective analytical study conducted in the department of Cardiology, Sir Salimullah Medical College and Mitford Hospital, Dhaka and NICVD, Dhaka, Bangladesh from March 2004 to February 2005. We have evaluated 80 patients with streptokinase treated STEMI who had both admission troponin I and ST-monitoring. We used a prospectively defined cut-off value of troponin I of 0.1ng/ml. For ST-segment resolution, a cut-off of 50% measured after 90 minutes was used. Both a troponin I >0.1ng/ml and ST segment resolution <50% was related to higher early mortality; 16.7% vs. 14.3% (p<0.001) and 57.1% vs. 1.7% (p<0.001) respectively. In a multivariate analysis ST-segment resolution was and troponin I showed a strong trend to be independently related to early mortality. The combination of both further improved risk stratification. The early mortality in the group with elevation of troponin I and without ST-segment resolution compared to the group without troponin I elevation and with ST-segment resolution was 55.6% vs. 0%. Both troponin I on admission and ST-segment resolution after 90 minutes are strong predictors of early mortality. The combination of both gives additive early information about prognosis and further improves risk stratification.